The Health & Wellbeing Board met on Thursday 21 January 2016 to discuss integrated care programmes for older adults and mental health, devolution updates, and commissioning intentions. The Board agreed to the Heads of Agreement Document for the Older Adults Programme and noted updates on both the Mental Health and Older Adults Programmes.

Whole Systems Integrated Care Programmes for Older Adults and Mental Health

The Board received an update on the Mental Health Programme being developed by NHS West London Clinical Commissioning Group (CCG) as part of Whole Systems Integrated Care. This programme is one of two pilot schemes in London, with extensive co-production involving service users, carers, local authorities, voluntary sector organisations, and statutory providers. The model of care is designed as a 'hub and spoke' system, with the entire patient journey being mapped. A separate strand of work is addressing child and adolescent mental health, with consideration being given to the transition from child to adult mental health services, including the needs of 12 to 25 year olds.

An update was also provided on the Older Adults Programme, which shares similar principles with the Mental Health Programme. This programme aims to provide high-quality, integrated care by recognising the holistic needs of older adults and engaging with the voluntary and community sector and carers. A core aim is the development of fully integrated care with shared patient records. Caseworkers, supported by healthcare assistants and overseen by GPs and social care workers, are being recruited. The programme went live in September 2015 with services at the St. Charles Integrated Care Centre and is expanding to the Violet Melchett Clinic. The St. Charles Integrated Care Centre has been revitalised and includes a presence from Age UK, along with case managers, mental health staff, and other services like footcare.

The Board discussed how the Older People Programme's pathways align with the Community Independence Service, emphasising the importance of patient understanding and involvement. Questions were raised about funding, including resources for the voluntary and community sector, and responsibility for individual care plans. The difficulty of obtaining GPs, nurses, and care workers from a single source, leading to potential service duplication, was also noted. Councillor Barrie Taylor requested a briefing on work addressing personality disorders. The Board agreed to the Heads of Agreement Document for the Older Adults Programme.

Devolution Update

Ezra Wallace, Head of Corporate Strategy, provided an update on devolution, referencing agreements within the London and Health Care Collaboration Agreement and the London Health and Devolution Agreement, both agreed on 14 December 2015. These agreements outline principles for collaboration to improve healthcare and how health and social care will operate. Five pilot schemes across London were announced as part of the Collaboration Agreement to test new ways of working. The Board noted that this new context would inform the refresh of its strategy and future operations. Members discussed potential changes and the extent to which London partners would remain answerable to government departments. The Chairman highlighted the need for the Board to have additional levers, such as greater control over NHS estates and contractual arrangements, to effectively deliver its objectives.

Commissioning Intentions

Matthew Bazeley presented the commissioning intentions for NHS Central London and NHS West London CCGs, stating no changes in strategy. He noted that NHS England's planning guidance in December 2015 provided direction for commissioning and contracts. Both CCGs had planned for financial allocations below inflation. NHS Central London CCG is developing a transformation plan to achieve £15 million in savings, which will involve changes in approach and prioritisation. Dr Philip Mackney raised concerns about complex coding issues potentially impacting patient figures, and Dr Neville Purssell noted significant variations in Urgent Care Centre visit numbers that required further investigation. Members sought reasons for NHS Central London CCG's financial deterioration and measures to ensure patients accessed the correct services, acknowledging that the number of new arrivals to Westminster complicated service demand management. Matthew Bazeley attributed the financial deterioration to general overactivity, including in intensive care, and suggested that providers could be contractually challenged through performance indicators to address incorrect service allocation. A strategic approach to negotiating 'block' contracts with providers was being adopted.

Westminster Health and Wellbeing Strategy Refresh

The Chairman introduced the refresh of the Board's strategy, noting its importance in light of devolution changes and the development of Health and Wellbeing hubs. The first report aimed to initiate the strategy refresh process, with suggestions welcomed from Members. Meenara Islam, Principal Policy Officer, presented the report, emphasising the need to consider the strategy in the context of 'more for less' and to focus on future themes while ensuring high-quality commissioning. Members were advised to consider systems issues and the Board's direction, as well as NHS England's five-year Sustainability and Transformation Plan (STP). Matthew Bazeley stressed the need for a system-wide financial sustainability plan as part of the STP, which needed to be embedded in the strategy refresh. A task group would be created to consider the strategy refresh and the Board's future operations, with draft proposals to be presented at the next meeting.

Primary Care Modelling

Stuart Lines, Deputy Director of Public Health, provided an update on primary care modelling. Phase 1, involving borough-wide projections and disease burden, was complete, and Phase 2 was underway, examining the impacts of regeneration, housing, and infrastructure plans on Westminster. Phase 3 will analyse the impact on frontline service demand. A workshop for analysts was scheduled for 27 January, with all Board Members invited. Rianne Van Der Linde, Public Health Analyst, presented work by the London Health Commission identifying 15 patient groups based on various factors. The estimated number and percentage of the population in Westminster for each group were provided, along with projected numbers of people living with cancer in 15 years and associated healthcare costs. The Chairman noted the project's value in identifying common themes and providing insight into future healthcare needs, including a likely increased demand for district nurses and links between healthcare and areas like housing and transport.

Health and Wellbeing Hubs Programme

Ezra Wallace presented an update on the Health and Wellbeing Hubs Programme, including an Older People's Pilot project and the Newman Street Pilot for single, homeless adults. Both pilots aim to increase access to services for disadvantaged groups. A review of the four older people's hubs indicated over 1,400 active users, with the Churchill Hub being the most frequently attended. Gaps identified included underrepresentation of men and challenges in reaching the housebound. While awareness among GPs had been raised, further improvements were needed. Opportunities exist to learn from the Whole Systems project to enhance offerings at specific CCG villages and to reduce duplication by developing an integrated offer with housing services. Members noted that the Chairman chaired a steering group overseeing workstreams to improve access to preventative services. An evaluation of the Newman Street pilot project, involving the Council, NHS Central London CCG, and Great Street Primary Care Centre, was underway, with a report expected in the spring. The Board agreed to a suggestion that the Joint Strategic Needs Assessment (JSNA) Team consider the issue of adult males being less likely to access services generally. Councillor Barrie Taylor requested that the report be sent to Church Street Ward Members and Members of other wards where the Older People's Pilot Project operated.

Better Care Fund and Community Independence Service

Chris Neill provided a verbal update on the Better Care Fund (BCF), noting the publication of policy guidance and the forthcoming technical guidance. Regarding the Community Independence Service, current commissioning arrangements were due to end in the coming months, and engagement with the provider market was ongoing. Members enquired about new BCF funding allocations, and Chris Neill undertook to investigate and provide a summary if the information was available. A formal review of the Community Independence Service would be considered at a future meeting.

Joint Strategic Needs Assessments: Childhood Obesity and End of Life Care

The Board considered two Joint Strategic Needs Assessments (JSNAs) for sign-off: Childhood Obesity and End of Life Care. Colin Brodie, Public Health Knowledge Manager, asked the Board to consider providing strategic leadership and oversight for the End of Life JSNA while an alternative lead was sought. Members expressed support for the End of Life Care JSNA in principle but required further details on delivery. The Board agreed to be given more time to consider the End of Life Care JSNA, with Members to provide feedback to the Chairman before a response was given regarding the request for strategic leadership. Regarding the Childhood Obesity JSNA, the Chairman welcomed the proposals, highlighting that tackling childhood obesity was a key Council priority with ongoing holistic work. Eva Hrobonova, Acting Tri-borough Director of Public Health, confirmed a comprehensive programme was in place to address childhood obesity, and a presentation on progress would be provided at a future meeting. The Board agreed to the sign-off and publication of the Childhood Obesity JSNA and to monitor its progress.